Children, Asthma and Sports

One of the primary goals of asthma management is to ensure that all children with a diagnosis of asthma are able to lead a normal healthy life.

A child with well controlled asthma should be able to sleep through the night without coughing or wheezing, should not miss school due to frequent asthma flares, and should be able to participate in athletic activities and sports as well as anyone.

Don’t Let Asthma Hold You Back!

The goal in pediatric asthma is to take control of one’s asthma so that it doesn’t take control of you. With good management, a child can not only plays sports, but can excel in sports. There are many elite athletes who have achieved excellence in their sport; there are even Olympic athletes who have asthma, and have set world records!

It is important to let your teacher and coach know that your child has asthma. You should also provide them with a copy of your asthma action plan and physician’s medication order form. Your child should have an albuterol inhaler available to him/her either in the school office, YMCA, after school program, with his/her coach for out of school sports, or on his/her person when playing sports.

What causes asthma in kids?

Asthma is a chronic inflammatory disease of the airways of the lungs. It consists of airway inflammation and excessive mucous production which causes airway narrowing, as well as muscle tightening around the airways which in turn also causes airway narrowing.

Your Genes

Researchers believe that heredity plays a major role in the tendency to develop asthma. Children who are likely to have asthma have inherited genes that make them susceptible to asthma. So, if a parent or sibling has allergies or asthma, it is likely you are at risk of also developing asthma. Asthma is caused by the interaction between a susceptible child and something in the environment.

Your Environment

Triggers in the environment cause the airways to become swollen and constricted, which then brings about asthma symptoms; these triggers can include dust, pollen, smoking and changes in weather. Children who were born prematurely, or those who have had a certain viral respiratory illness as babies, are also at risk of developing asthma.

Asthma in younger children (toddlers and preschoolers) is generally caused by a viral infection. Most pediatric asthma is allergic asthma.  Currently, asthma cannot be cured but it can be controlled.

What is “exercise induced” asthma?

In some children, exercise alone might be the only trigger for their asthma, though many children with asthma experience symptoms with physical activity and exercise. If not properly diagnosed and treated some children might avoid exercise altogether. Children with exercise induced asthma might experience shortness of breath, chest tightness, cough or wheezing 5-20 minutes after exertion begins. These symptoms tend to occur more frequently when the air is cold and dry or with strenuous activity.

Treating exercise induced asthma with medications prescribed by your physician, as well as following some simple tips, can allow almost all children to be able to exercise and play their favorite sport.

Sports less likely to cause asthma symptoms:

• Swimming
• Walking
• Biking
• Team sports that involve short bursts of energy (baseball, football, volleyball, tennis, wrestling, gymnastics)

Sports more likely to cause asthma symptoms:

Endurance sports that require more continuous activity are more likely to trigger asthma. These include:

• Soccer
• Basketball
• Hockey
• Long distance running

Tips for exercising with asthma:

• Warm up before you exercise
• Cool down slowly after exercise
• Exercise in a warm place, like a gym
• Cover your nose and mouth with a loose scarf during cold weather

Are there times when a child should NOT participate in a sport?

A child should not participate in a sport if his asthma is currently unstable or not in control. Symptoms of an asthma flare are: cough, wheezing, shortness of breath, chest pain/tightness. Pollen and air pollution are common triggers for many children, so a child may want to avoid outdoor exercise during dangerous air quality days.

How young can a child develop asthma?

Infants frequently have wheezing associated with viral respiratory infections. This is not always asthma, however some of these children will later on receive a diagnosis of asthma. It is difficult to determine after just one or two wheezing episodes if a child has asthma. “Not all that wheezes is asthma”. If respiratory symptoms of cough, chest tightness or wheeze are frequently present without a viral infection, such as when the child is exposed to certain triggers (cigarette smoke, animals, exercise, pollen), then the diagnosis of asthma is likely to be made.

Signs & Symptoms of Asthma in Children

Signs and symptoms of asthma in children include:

• Coughing
• Wheezing
• Shortness of breath
• Chest pain

Other possible signs/symptoms of asthma include:

• Persistent cough that wakes a child up more than two nights a month
• Persistent cough that occurs more than twice a week during the day
• Cough, wheezing, shortness of breath or chest pain during or after exercise
• Significant coughing/wheezing with each cold

Signs of Severe Respiratory Distress

Seek medical help immediately if your child experiences the following:

• Breathing hard and fast
• Pulling in of ribs or stomach muscles (retractions)
• Opening and closing of nostrils (flaring)
• Inability to talk
• Dusky or blue color to lips, nails and face

When should your bring your child to a doctor for asthma?

If your child experiences the above symptoms routinely, especially after having a cold or other viral infection, during or after exercise, or is woken up at night by these symptoms, they should see their doctor.

Make an appointment with your primary doctor or pediatrician to have your child evaluated for possible asthma. You should also bring your child to see a doctor if he/she has had a chronic cough for several weeks. Cough is a major symptom of asthma, but it is important to note that “not all that coughs or wheezes is asthma”.

Determining Whether Your Child Has Asthma

In order to determine whether your child has asthma, your doctor will take a very detailed history. They will also want to know:

• How many days a week your child coughs or wheezes during the day, during the night, or with exercise
• If your child has any seasonal allergies to pollen or mold
• Whether anyone in the home smokes
• Whether there is a family history of eczema or allergic rhinitis

Physical Exam

Your doctor will then perform a physical exam. During this exam, your doctor will:

• Look for signs of inflammation in the nose
• Listen to your child’s breathing for signs of wheezing
• Look at your child’s chest and stomach muscles to see if they are pulling in and out when breathing
• Look at your child’s skin for signs of dry skin/rash/eczema.

More detailed testing could involve a chest X-ray, allergy testing via a blood draw or skin pricks, or a peak flow assessment to see how fast your child can blow air out of his lungs.

An even more detailed test is a pulmonary function test, which uses a computerized machine called a spirometer to measure the amount of air your child can blow out from his lungs over time. All of these methods assist your doctor in making a diagnosis of asthma.

About Michele Florence, RN, BSN

Michele Florence is a Clinical Asthma Education Specialist in the WakeMed Physician Practices Pediatric outpatient department. She has been a pediatric RN for 30 years and started her nursing career at Children’s National Medical Center in Washington DC, working with high risk infants and toddlers with chronic medical problems. She then worked in the Children’s ED at WakeMed for 17 years where she developed a passion for asthmatic patients. Today, she applies her experience towards the prevention and control of asthma in children.